Question

Anish was looking for a way to spend his summer break, so he decided to volunteer with a medical mission team going to staff a clinic in an impoverished rural region of India. At the briefing meeting, Anish and the other volunteers were warned that with the onset of the rainy season in August, they would be seeing patients with cholera, an acute diarrheal disease caused by the bacterium Vibrio cholera. Toxins from the cholera bacterium cause vomiting and massive volumes of watery diarrhea in people who consume contaminated food or water. Unless treated promptly, cholera can be fatal.

Cholera is endemic in parts of India, meaning that it occurs on a regular basis. A volunteer trained by the U.S. Centers for Disease control and prevention (CDC) spoke to the medical mission team about what to expect when treating patients and also about proper precautions for themselves. He explained that the oral cholera vaccine they had taken would protect against the O1 strains but the area they would be visiting also had the newer O139 strain not covered by the vaccine. Once in India, everything went well at the clinic initially. Then about five days into his trip, Anish has several bouts of copious and watery diarrhea. When he developed dizziness and a rapid heartbeat, he visited the medical officer for the team. There, he was diagnosed with dehydration from cholera-induced diarrhea.

Given Anish’s watery diarrhea, what would you expect his ECF volume to be?

Why was Anish experiencing a rapid heartbeat?

Esomeprazole is a proton pump inhibitor. For what symptom or condition might Anish have been taking this drug?

Why might taking a protein pump inhibitor like esomeprazole have increased Anish’s chances of contracting cholera?

Why would continuously open enterocyte CFTR channels cause secretory diarrhea and dehydration in humans?

Which type of IV solution would you select for Anish, and why? Your choices are normal (isotonic) saline, half-normal saline, and 5% dextrose in water (D-5-W).

Answer 1

Question no 1

Anish extracellular fluid volume would be very low as it is indicated that he is dehydrated and also having a watery diarrhea. So his output of fluid volume is higher. This will lead to reduction in the ECF volume.

Question no 2

Anish is experiencing a rapid heart beat as he is having watery diarrhea and is dehydrated, this will lead to excessive reduction in blood pressure of the patient. This will cause the patient heart to increase Heart rate to compensate for the reduction in the BP .

Question no 3

Esomiprazole is taken by the patient to prevent the formation of peptic ulcer as a result of low good in stomach and excretion of food from stomach due to diarrhea. This action is a result if proton pump inhibition which case reduction in HCL level of stomach

Question no 4

Use of esomiprazole will lead to reduction of the HCl in stomach. This HCl is the main cause for acidic atmosphere of stomach and when this acidic atmosphere is removed it will lead to more susceptibility towards cholera infection.